1. Chief Clinical & Nursing Informatics Officer
Patient Centered vs Standardized Processes & Documentation for Pain Management
Anne LaFlamme, DNP, RN
Chief Clinical & Nursing Informatics Officer
VP Health Informatics
MHealth Fairview

2. Objectives Identify Demonstrate Understand Discuss
Identify processes and tools to optimize the implementation of a new pain assessment tool
Demonstrate
Demonstrate tools used to prepare for successful implementation of a new pain assessment tool
Understand
Understand the balance between standardization and customization as they pertain to patient-centered care, clinical practice, and documentation
Discuss
Discuss how use of non-standard documentation affects implementation of the pain information model

3. Work Breakdown Structure
Exercises
Problem Statement
Fishbone Diagram
Work Breakdown Structure
Smart Goals
Project Plan
Outcomes Measurement

4. Situation
Your pain champion needs your help investigating supplemental or alternative pain assessment tools for use in an adult inpatient setting. 

5. How would you rate your pain on a scale from 0-10, 0 being no pain and 10 being the worst pain you can imagine?

7. "Problem Statement"
There must be something better!

8. Numeric Rating Scale PROS CONS Standardized tool
Number influenced by multiple factors internal & external
Easy to use
Unable to use in all situations
Patient's subjective report of their pain
Report is subjective for patient and clinician
Measurements can be tracked & trended over time
Single measurement at a single point in time independent of other factors
Comparable within the tool
Cannot compare across pain tools
Shareable, Interoperable
Not semantically interoperable
Exercise to have them identify the problem statement?

9. Exercise 1 Define your problem statement
Share with two of your neighbors

10. Fishbone Diagram People Process / Policy Product Problem or Outcome
Environment
Equipment / Supplies

11. Exercise 2
Complete a Fishbone Diagram for your problem statement

12. Search Results Clinically Aligned Pain Assessment tool (CAPA©)
Assesses pain using a transactional conversation between patient and clinicians
Copyright: Donaldson & Chapman, 2013, University of Utah
Modified for use (with permissions) at University of Minnesota Medical Center

13. How has your comfort level been?
It's manageable except when I get up to go to the bathroom.

14. No; the pain is better than yesterday.
Is this a change for you?

15. It's been effective. I'd like to try taking it every 6 hours instead.
I see you've been taking 1 Percocet every four hours; how effective has that been to address your pain?
It's been effective. I'd like to try taking it every 6 hours instead.

16. Drew & Topham, 2014

17. CAPA© PROS CONS Standardized tool Newer tool; less used
Guided patient – clinician conversation 
Requires conversational skills
Considers multiple factors of the pain experience over time
Measurements difficult to track & trend visually over time
Comparable within the tool
Cannot compare across tools
Improved semantic "operability"
Not interoperable 

18. Goal Definition

19. Process & Outcome Measures
Process Measures
Weekly documentation compliance by unit
Identification of continued NRS use by user
Outcome Measures
CAPA outcomes
Patient satisfaction scores

20. Exercise 3 Adapt these process and outcome measures into SMART goals
Process Measures
Weekly documentation compliance by unit
Continued NRS use by user
Outcome Measures
CAPA outcomes
Patient satisfaction scores

21. Work Breakdown Structure
Lists the work to be done
Break down implementation activities into manageable steps 
Group work into larger buckets of work
Identify critical paths and dependencies
Post-its, markers, large post it / paper

22. This Photo by Unknown author is licensed under CC BY-NC-ND.

23. WBS Example CAPA © Implementation Evaluation Documentation
Interview University of Utah
Request copyright permissions
Gather documentation requirements
Perform lit search

24. Exercise 4
With your table, begin your work breakdown structure.

25. Project Plan
Drew & Topham, 2014

26. Exercise 5
Use the WBS to create a high-level project plan.

27. Measurement
Think about how you would visualize your process and outcome metrics 

28. Tracking Tool - Documentation
Drew & Topham, 2014

29. Tracking Tool – Patient Survey
Drew & Topham, 2014

30. Tracking Tool
Drew & Topham, 2014

31. Tracking Tool

32. Tracking Tool
Drew & Topham, 2014

33. Discussion
As a new pain assessment tool, what effect does the use of CAPA© have on patient-centered care, clinical practice, and documentation?
How would you address CAPA© in the context of the pain information model?
Should CAPA© be mapped to Snomed-CT & LOINC as part of the pain information model?
Understand
Understand the balance between standardization and customization as they pertain to patient-centered care, clinical practice, and  documentation
Discuss
Discuss how use of non-standard documentation affects implementation of the pain information model

34. References
Donaldson, G. & Chapman, C. R. (2013). Pain management is more than just a number. University of Utah Health / Department of Anesthesiology. Salt Lake City, Utah: Department of Anesthesiology.
Drew, D. J. & Topham, D. (2014). Implementation of the  CAPA© (Clinically Aligned Pain  Assessment) Tool: Pain is More than Just a Number©. Retrieved from:
University of Utah Health Care. (2012). Give patients  voice, not a number. Retrieved from: 
Donaldson, g and chapman, c.r Pain is more than just a number. University of utah